title: The impact of novel therapeutic agents before and after frontline autologous stem cell transplantation in patients with multiple myeloma.
abstract: BACKGROUND
  Novel agents (NAs) such as thalidomide and bortezomib have been administered in combination with autologous stem-cell transplantation (ASCT) to effectively treat multiple myeloma (MM). However, whether NAs perform better as induction treatments prior to transplantation, or as post-transplant maintenance therapies remains unclear.
  
  
  METHODS
  We retrospectively analyzed 106 consecutive patients with MM who underwent ASCT within 1 year of diagnosis as first-line therapy.
  
  
  RESULTS
  Eighty-seven (82.1%) patients received NAs before ASCT, whereas 68 (64.2%) received NAs after ASCT. NAs were administered to each patient as follows: before ASCT alone (N=29, 27.4%), after ASCT alone (N=10, 9.4%) or both before and after ASCT (N=58, 54.7%). High-quality rates before and after ASCT were significantly higher for patients who received NAs as induction treatment compared to those who did not receive pre-transplant NAs. At a median follow-up of 37.9 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 42.8% and 70.2%, respectively. The PFS and OS were significantly higher in patients with NAs as post-transplant maintenance treatment (P=0.03 and P=0.04, respectively), but not in those with NAs as pre-transplant induction treatment. The PFS of patients with NAs before and after ASCT was higher than that of the patients with NAs as induction therapy alone (P=0.05). Age, serum β2-microglobulin level, complete response after ASCT, and NA use post-ASCT independently predicted survival outcomes.
  
  
  CONCLUSIONS
  These findings suggest that integration of NAs post-ASCT could benefit patients with MM undergoing ASCT. Induction therapy using NAs also improves high-quality response rates before and after ASCT.
authors.affiliation: Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Seung-Ah
authors.initials: SA
authors.lastname: Yahng
authors.forename: Byung-Sik
authors.initials: BS
authors.lastname: Cho
authors.forename: Ki-Seong
authors.initials: KS
authors.lastname: Eom
authors.forename: Yoo-Jin
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hee-Je
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.forename: Seok-Goo
authors.initials: SG
authors.lastname: Cho
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Chong-Won
authors.initials: CW
authors.lastname: Park
keywords: Autologous stem cell transplantation; Induction and maintenance treatment; Multiple myeloma; Novel agents